血清游离轻链检测在多发性骨髓瘤诊治中作用的临床评价

The clinical value of serum free light chain measurement in multiple myeloma

目的:检测正常人群血清游离轻链(sFLC)水平,确定我院sFLC正常参考值范围,并研究其与性别、年龄的相关性。通过检测多发性骨髓瘤(MM)患者sFLC水平探讨其在MM诊断及化疗疗效评价中的作用。方法:选取健康体检者存留标本403例,应用免疫散射比浊法测定sFLC水平得出sFLC正常参考值范围。选取明确诊断为MM的58例初诊患者,对32例MM患者进行治疗反应的观察。结果:我院sFLC正常参考值范围为κFLC:5.81～24.04mg/L,λFLC:6.72～22.81mg/L,游离轻链比值(ratio of FLC,rFLC):0.59～1.46,sFLC水平及rFLC与性别及年龄无关。58例初诊MM患者血清κFLC、λFLC及rFLC阳性率为100%,血清免疫固定电泳(IFE)阳性率为98.3%,血清蛋白电泳(SPE)阳性率为92.3%,免疫球蛋白(Ig)定量检测阳性率为91.1%,而尿游离轻链(uFLC)检测阳性率为55%。结论:我院sFLC正常参考值范围与国外报道略有不同,sFLC及rFLC与性别及年龄无关。在MM诊断方面,sFLC检测的敏感性优于IFE、uFLC、SPE、Ig定量。sFLC的检测对于判断病情及化疗疗效监测具有重要意义。

Objective：To detect serum free light chain（sFLC）of healthy people in order to establish normal reference intervals of the sFLC and explore its clinical significance in the diagnosis and response monitoring of mul- tiple myeloma（MM）. Method： sFLC was detected in 403 healthy people who took physical examinations using im munonephelometric assay to establish normal reference intervals of the sFLC. 58 MM patients who was diagnosed in our hospital were included and clinical significance of sFLC in the diagnosis and response monitoring of MM were explored in 32 patients who were treated in our cancer center. Result：Normal reference intervals of FI.C in our hospital are as follows. ~FLC：5. 81--24. 04 mg/L,λFLC：6. 72--22. 81 mg/L,ratio of FLC：0. 59--1. 46. The level of sFLC and rFLC has no correlation with sex and age. In 58 newly diagnosed MM patients, the positive rate of sFLC is 100%,the positive rate of serum immnofixation electrophoresis（IFE）is 98.3G ,the positive rate of serum protein electrophoresis（SPE）is 92.3G, the positive rate of immunoglobulin（Ig）measurement for intact immuno- globulin multiple myeloma（lIMM）is 91. 1%, and the positive rate of urine FLC（uFLC） is 55 %. Conclusion： Normal reference intervals of sFLC in our hospital are different from overseas, the level of sFLC and rFLC is not correlated with the sex and age. In the diagnosis of MM,the sensitivity of sFLC is better than IFE,SPE,uFLC and Ig meas- urement,and sFLC measurement can improve the diagnostic specificity combined with other traditional measure- ments. The FLC measurement is very important for response monitoring of MM.